NBME Step 2 CK Form 7 Intravascular volume depletion (NBME Answers)

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Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 1/Question#26 (reveal difficulty score)
A 47-year-old woman comes to the physician ...
Intravascular volume depletion 🔍 / 📺 / 🌳 / 📖
tags: endo inc

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submitted by ∗jesusisking(31)

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Did anyone else think autonomic insufficiency given the diabetes? I know it was previously well controlled but still a 10 year history

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seagull ya dude. +

charcot_bouchard You wouldn't expect baseline low BP at that case. Also other features like fever suggest alt dx +

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submitted by ∗step_prep5(246)

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Middle-aged woman with potential infectious disease (fever) leading to one week of uncontrolled hyperglycemia who has signs of orthostatic hypotension (drop in systolic BP >20 or diastolic BP >10 when moving from sitting to standing) and is found to have glucosuria, most consistent with intravascular volume depletion due to glucose acting as an osmotic agent and leading to polyuria
Key idea: Infections often lead to increased insulin requirement by causing a reactionary hyperglycemia

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antwon Would this be stress hyperglycemia? meaning stress would lead to gluconeogenesis, glycogenolysis, and insulin resistance. Therefore more glucose in the urine and therefore glucosuria. +

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submitted by ∗buttercup(18)

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Osmotic diuresis caused by glucosuria is one of the most common causes of excessive renal salt and water loss.

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russnels What would cause the acute increase in blood glucose concentrations? +1

study_dude_guy I think this question is getting at HHS. The glucose levels are way lower than typical HHS but the patient has a fever and WBCs in the urine so MAYBE a UTI (even though it doesn't say anything about UTI symptoms) +

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submitted by ∗russnels(20)

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I was initially thinking adrenal insufficiency, but that is wrong b/c you would actually expect to see HYPOglycemia, not worsened hyperglycemia. You would still expect to see hypotension, however.

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submitted by ∗charcot_bouchard(574)

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Adrenal insufficiency will cause - If primary (i.e loss of both cort and aldo) : u have refractory hypotension. not only postural

Only aldo loss (like drug induced) can cause postural drop but thats highly ulikely here and its not called adrenal insufficiency.

here, infection > Fever (both cause vasodilation)

Infection > stress hyperglycemia > oosmotic diuresis > Fluid loss

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